What Is Squamous Cell Cancer
Squamous cell carcinoma of the skin is a common skin cancer that typically develops in chronic sun-exposed areas of your body. This type of skin cancer is usually not nearly as aggressive as melanoma and is uncontrolled growth of cells in the epidermis of your skin.
It can become disfiguring and sometimes deadly if allowed to grow. Squamous cell carcinomas are at least twice as frequent in men as in women. They rarely appear before age 50 and are most often seen in individuals in their 70s.
An estimated 700,000 cases of SCC are diagnosed each year in the United States, resulting in approximately 2,500 deaths.
Treating Squamous Cell Carcinoma
Most of squamous cell carcinomas can be cured if they are treated early. Once squamous cell carcinoma has spread beyond the skin, though, less than half of people live five years, even with aggressive treatment.
There are many ways to treat squamous cell carcinoma that has not spread. These include:
- cutting away the cancer and a small amount of healthy tissue around it. If a large area of skin is removed, a skin graft may be necessary.
- scraping away the cancer with a surgical tool. An electric probe is used to kill any cancerous cells left behind.
- freezing cancer cells with liquid nitrogen. This treatment is usually used only for very small tumors or for a patch of skin that looks abnormal but isn’t yet cancerous.
- destroying the tumor with radiation.
- shaving away the cancer, one thin layer at a time. Each layer is examined under the microscope as it is removed. This technique helps the doctor preserve as much healthy skin as possible.
- applying drugs directly to the skin or injecting them into the tumor
- using a narrow laser beam to destroy the cancer.
The treatment that is best for you depends on the size and location of the cancer, whether it has returned after previous treatment, your age, and your general health.
Once your treatment is finished, it’s important to have regular follow-up skin exams. Your doctor may want to see you every three months for the first year, for example, and then less often after that.
How To Tell If Squamous Cell Carcinoma Has Spread
While its not common for squamous cell carcinoma to spread, it is helpful to be mindful of the signs. First, there are certain known risk factors to be aware of, as these characteristics have been associated with a higher stage of squamous cell carcinoma. Risk factors for squamous cell spreading include:
- The tumor is thicker than 2 millimeters.
- The tumor has grown into the lower dermis or subcutis layers of the skin.
- The tumor has grown into the nerves in the skin.
- The tumor is present on the ear or on a hair-bearing lip.
Knowing the stage of your cancer will help your medical team understand how serious it is and how best to treat it. Staging squamous cell carcinoma is based on a physical exam, detailed history, skin biopsy, lymph node biopsy, and imaging studies.
To determine if your cancer has spread, your physician may recommend several diagnostic tests. A skin or lymph node biopsy can show how far cancer cells have spread in the region of the primary tumor. Your medical team may also recommend a computed tomography scan to determine the spread.
You may also be able to recognize squamous cell carcinoma spreading by its appearance. Possible symptoms of squamous cell carcinoma include:
- A thick, red, scaly patch of skin
- An open sore or scar
- An elevated growth that is usually pink, red, or the color of your flesh.
- A wartlike nodule with raised edges
While most squamous cell carcinoma lesions are painless, it is possible to experience pain or numbness at the site.
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What Is Invasive Squamous Cell Carcinoma
Invasive squamous cell carcinoma occurs when this form of skin cancer is left untreated, allowing it to develop deeper into the body and surrounding tissues. How serious is invasive squamous cell carcinoma? Any cancer that progresses to its later stages will be more difficult to beat, especially if it has spread.
When To Seek Help
Not all sores on the skin are skin cancer. But if you do develop a skincancer, the earlier it is treated, the better the outcome for you.
Most people find SCCs by checking their own skin. Check your skin regularly so you notice any changes. See a doctor if:
- you have a sore that doesn’t heal in 2 months
- you notice a new and unusual looking spot
- an existing spot changes in colour, size or shape
- you have a spot that is asymmetrical
- you have a spot with an uneven border
- you have a spot with an unusual or uneven colour
- you have a spot that is larger than 7 mm
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Cancer Stage Determines Risk Of Spreading And Line Of Treatment
A cancer of the upper layers of the skin in the epidermis, SCC is the second most common form of skin cancer after basal cell carcinoma and affects an estimated 1 million new people every year in the United States alone. Cancer staging is done for SCC with the intention of categorizing the size of cancer and to judge how much it has grown. And theres a clear line of treatment and way forward for each stage.1
With skin cancers like basal cell carcinoma, the likelihood of cancer spreading to other parts of the body is very low and early diagnosis and treatment usually tackles the problem before it spreads. SCC, however, is a little trickier. While the risk of spreading is still quite small, there is a relatively higher chance of it progressing depending on what stage the cancer is at. For those with weakened immune systems, say, people whove had organ transplants or anyone infected with HIV, the risk is a little higher. Also, when the cancer is in the head and neck region, it may have a slightly higher risk of recurring or spreading.2
The actual stage of this form of cancer is determined based on the TNM protocol devised by the American Joint Commission on Cancer.3
- T : The size/extent of the tumor
- N : Whether it has spread to lymph nodes
- M : Whether it has spread to other parts of the body
What Is The Outlook For People With Squamous Cell Cancer
Early detection of SCC is key to successful treatment. If SCC isnt treated in its early stages, the cancer may spread to other areas of the body, including the lymph nodes and organs. Once this occurs, the condition can be life threatening.
Those with weakened immune systems due to certain medical conditions, such as HIV, AIDS, or leukemia, have a greater risk of developing more serious forms of SCC.
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How Serious Is Invasive Squamous Cell Carcinoma
Skin cancer in general is a slow-developing disease, often taking years to develop, but that does not mean treatment should be delayed. The longer squamous cell carcinoma is ignored, the more time it has to become invasive, potentially burrowing deeper into nearby organs, lymph nodes, and even bones.
- Stage 0: known as carcinoma in situ, this stage means the cancer cells are localized in the topmost layer of the skin
- Stage I: the cancerous area is under 2cm and has not spread
- Stage II: the cancerous area is over 2cm and may have spread to nearby tissue but not lymph nodes
- Stage III: the cancerous area can be any size and has started to spread to lymph nodes
- Stage IV: the cancerous area has become invasive, spreading to other major parts of the body
Delaying squamous cell carcinoma treatment increases risk significantly, so its important to seek medical attention as soon as you notice symptoms.
How Serious Is A Squamous Cell Carcinoma
Id had a few skin cancers removed before, all basal cell carcinomas , the most common type. But when I was diagnosed with a squamous cell carcinoma on my scalp, it seemed different, and a little more scary. I asked C. William Hanke, MD, a Mohs surgeon at the Laser and Skin Surgery Center of Indiana and a senior vice president of The Skin Cancer Foundation, what we need to know about this second most common form of skin cancer.
Q: When people talk about nonmelanoma skin cancers, they tend to lump basal cell and squamous cell carcinomas together as the ones that are far less dangerous than melanoma. Should we take SCCs more seriously?
Dr. Hanke: Yes and no. BCCs hardly ever metastasize. Ive seen two cases in my entire career. But when SCCs that havent been treated early get big, then the chance of metastasis becomes real. Its uncommon, but its much more common than in BCC. We see it in our practice. But we dont want to scare people into thinking that just because they have squamous cell, Oh wow, Ive got a chance of metastasis. Remember, the rate is very low. Its just those big ones.
Q: OK, so its rare. But what happens when an SCC does spread?
Q: Whats the usual treatment for SCCs?
Q: How can we detect SCCs as early as possible?
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What Is The Treatment For Cutaneous Squamous Cell Carcinoma
Other methods of removal include:
- Shave, curettage, and electrocautery for low-risk tumours on trunk and limbs
- Aggressive cryotherapy for very small, thin, low-risk tumours
- Mohs micrographic surgery for large facial lesions with indistinct margins or recurrent tumours
- Radiotherapy for an inoperable tumour, patients unsuitable for surgery, or as adjuvant
References And Information Sources Used For The Article:
Wolff, K., & Johnson, R. A. . Fitzpatricks color atlas and synopsis of clinical dermatology. McGraw-Hill Medical.
Thiers, B. H. . Year Book of Dermatology 1988. Archives of Dermatology, 125, 1150.
Burns, T., & Breathnach, S. . Rooks Textbook of dermatology Vol 4. London: Blackwell Scientific Publications, 1992.
Bolognia, J. L., Schaffer, J. V., Duncan, K. O., & Ko, C. J. . Dermatology Essentials E-Book. Elsevier Health Sciences.
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What Makes Yale Medicines Approach To Squamous Cell Carcinoma Unique
Simple, small cancers can often be treated very well by a local dermatologist, according to Dr. Leffell. We rarely see the small cancers. We get referred to the cases that need special attention.
Dr. Leffell emphasizes that at Yale Medicine, the patient always comes first. We like to have a discussion with the patient about what happens after the skin cancer is removed, he says. We talk about what’s involved with plastic surgery and what’s involved with letting the area heal naturally. We prefer to take a minimalist approach and let the patient decide what they want us to do and how they want to let their skin heal.
If the decision is made to repair the wound using plastic surgery, we do that immediately in the office setting, Dr. Leffell says. Alternatively, allowing the wound to heal naturally is often a great option, and does not rule out doing plastic surgery down the road if needed, though that is very rarely the case.
What Does Squamous Cell Carcinoma Look Like
Squamous cell carcinomas most often affect areas with lot of sun exposure such as the face, scalp, neck, ears, backs of hands, forearms, and shins. Squamous cell carcinomas can occur in many other areas of the skin. Squamous cell carcinoma often looks like a rough scaly spot, scab or sore that just will not heal. They tend to bleed easier than normal skin.
Scabs and scratches typically heal within 4 weeks. Skin cancer does not heal because the cells are abnormal. If you have a non-healing scab or sore, and it has been more than 4 weeks you should call your dermatologist to have this spot examined.
It is very important to note that while these characteristics are some of the most common signs of squamous cell carcinoma, there is no substitute for your skin concern being examined in person by a Board-Certified Dermatologist. This is the gold standard for having any of your skin concerns addressed. Your Board-Certified Dermatologist will perform a comprehensive examination and is the expert when it comes to diagnosis and treating skin cancers.
What causes squamous cell carcinoma?
How is squamous cell carcinoma diagnosed?
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Tumour Staging For Cutaneous Scc
TX: Th Primary tumour cannot be assessed
T0: No evidence of a primary tumour
Tis: Carcinoma in situ
T1: Tumour 2cm without high-risk features
T2: Tumour 2cm or Tumour 2 cm with high-risk features
T3: Tumour with the invasion of maxilla, mandible, orbit or temporal bone
T4: Tumour with the invasion of axial or appendicular skeleton or perineural invasion of skull base
What Is Skin Cancer
Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control.
Skin cancer cells can sometimes spread to other parts of the body, but this is not common. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin.
Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, its still called skin cancer.
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Squamous Cell Skin Cancer Of The Head And Neck Treatment
Surgery is the preferred management method for the majority of squamous cell skin cancers. Low-risk, early stage, small squamous cell cancers can be removed by Mohs surgery, which is a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Excision, curettage and desiccation, and cryosurgery can also be used to remove the cancer while sparing normal tissue. Radiation alone is an alternative for low-risk tumors when surgery is not desirable because of cosmetic concerns or medical reasons.
Large tumors and tumors with nerve or lymph node involvement are not suitable for Mohs surgery and require removal of at least 5-millimeter margins of normal tissue around the cancer and neck dissection for involved lymph nodes. Larger tumors require reconstruction, which can be done at the time of surgery if margin status is clear. Reconstruction should be staged when margins status is not clear.
Patients with high-risk tumors should meet with a radiation therapist to discuss postoperative radiation. Chemotherapy may be added to radiation for extensive lymph node involvement or positive margins that cannot be cleared with additional surgery. In patients with high-risk tumors who are not surgical candidates, systemic treatment with both radiation and chemotherapy is used. Such cases require multidisciplinary care by a team of surgeons, radiation oncologists and medical oncologists.
What Are The Risk Factors For Skin Cancer
The most common risk factors for skin cancer are as follows.
- Ultraviolet light exposure, either from the sun or from tanning beds. Fair-skinned individuals, with hazel or blue eyes, and people with blond or red hair are particularly vulnerable. The problem is worse in areas of high elevation or near the equator where sunlight exposure is more intense.
- A chronically suppressed immune system from underlying diseases such as HIV/AIDS infection or cancer, or from some medications such as prednisone or chemotherapy
- Exposure to ionizing radiation or chemicals known to predispose to cancer such as arsenic
- Certain types of sexually acquired wart virus infections
- People who have a history of one skin cancer have a 20% chance of developing second skin cancer in the next two years.
- Elderly patients have more skin cancers.
Most basal cell carcinomas have few if any symptoms. Squamous cell carcinomas may be painful. Both forms of skin cancer may appear as a sore that bleeds, oozes, crusts, or otherwise will not heal. They begin as a slowly growing bump on the skin that may bleed after minor trauma. Both kinds of skin cancers may have raised edges and central ulceration.
Signs and symptoms of basal cell carcinomas include:
Signs and symptoms of squamous cell carcinomas include:
- Persistent, scaly red patches with irregular borders that may bleed easily
- Open sore that does not go away for weeks
- A raised growth with a rough surface that is indented in the middle
- A wart-like growth
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Treating Advanced Squamous Cell Cancers
Lymph node dissection:Removing regional lymph nodes might be recommended for some squamous cell cancers that are very large or have grown deeply into the skin, as well as if the lymph nodes feel enlarged and/or hard. The removed lymph nodes are looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.
Immunotherapy: For advanced squamous cell cancers that cant be cured with surgery or radiation therapy, one option might be using an immunotherapy drug such as cemiplimab or pembrolizumab . However, these drugs havent been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isnt clear.
Systemic chemotherapy and/or targeted therapy:Chemotherapy and targeted therapy drugs might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.